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Pharmacology > Inhalation Anesthesia 3 > Flashcards

Inhalation Anesthesia 3 Flashcards

1
Q

What happens to MAP with increases in concentration of des/iso/sevo in dose dependent manner?

A

MAP decreases

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2
Q

What effects does N2O have on BP?

A

Unchanged or even mildly increased MAP.

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3
Q

What effect does halothane have on MAP and CO?

A

Decreases MAP by decreasing CO.

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4
Q

Isoflurane, a linear dose dependent increase in HR after what MAC?

A

0.25 MAC

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5
Q

What are HR effects of sevoflurane?

A

HR does not increase until concentrations >1.5MAC

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6
Q

What are the studied effects of desflurane on HR?

A

Min increase in HR <1 MAC.

At >1MAC, linear dose dependent increase in HR is observed

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7
Q

What are the more clinical experiences with desflurane on HR?

A

When you overpressurize you will see some significant tachycardia.

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8
Q

What is the calculation to determine if tachycardia will be seen with desflurane adminsitration?

A

If percent concentration multiplied by gas flow is greater than 24, you will see tachycardia.

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9
Q

What are the changes seen in cardiac index with inhalation agents?

A

Minimally influences by inhalation agents.

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10
Q

What effect do inhaled agents have on dysrhythmogenicity (other than halothane)?

A

Inhaled agents do not predispose the heart to PVCs.

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11
Q

What effect do inhaled agents have on QT interval?

A

All prolong QT interval, but sevoflurane should be avoided with congenital long QT syndrome

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12
Q

What is coronary steal?

A

Isoflurane’s ability to dilate small diameter coronary arteries might cause a susceptible patient to develop regional myocardial ischemia as a result of coronary vasodilation.
(not found valid).

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13
Q

What is ischemic preconditioning?

A

Helps protect the heart by insulting the heart just a little. Gets preconditioned by minor insult then protects the heart from larger ischemic event.

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14
Q

There are two distinct periods of protection, what are they?

A

First period-
-1-2 hrs after conditioning
Second Period-
- Reappears 24hrs later and can last up to 3 days

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15
Q

What chemically happens that protects the heart in ischemic preconditioning?

A

Opening of mitchondrial ATP sensitive K+ATP channels.

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16
Q

Without the presence of other agents, what effect do inhalation agents have on RR and TV?

A

Increased RR and decreased TV.

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17
Q

What happens to MV with inhalation agents?

A

Stays about the same (>RR,

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18
Q

What happens to chemoreceptors?

A

Blunted response of central chemoreceptors. May have to get 45-50 before start breathing again.

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19
Q

Which stimulation response is strong: hypoxia or hypercarbia?

A

Hypoxia, we just don’t use it.

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20
Q

Which agent is “nicest to breathe”?

A

Sevoflurane, halothane, N2O.

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21
Q

What agents are worst to breath (pungent)?

A

Desflurane and isoflurane.

22
Q

What patients should you be cautious using a pungent anesthetics like des and iso?

A

Asthma, reactive airway disease, COPD, smokers

23
Q

Which inhalation agents causes increases in CMRO2?

A

N2O

24
Q

What changes in CNS effects can be seen around (above or below) 1 MAC?

A

ICP increases with all anesthetics at > 1 MAC.
Autoregulation is impaired at concentrations 1 < MAC.
Evoked potentials may be abolished at 1 MAC.

25
Q

Though 0.2-0.3 MAC can decrease the reliability of motor evoked potentials, what other medication actually has a bigger effect?

A

NMBA

26
Q

Which inhalation agent will we not use in patients with seizure history?

A

Sevoflurane

27
Q

At what MAC might you see isoelectric EEG pattern?

A

1.5-2.0 MAC

28
Q

true or false.

Inhalation agents have limited effect on the principle of hypoxic pulmonary vasocontriction?

A

True

29
Q

Which agent would you avoid in head trauma/intracranial processes?

A

N2O

30
Q

Which medication can counteract the negative effects of N2O in intracranial processes?

A

Barbs, opiods, or propofol

31
Q

What happens to autoregulation <1 MAC?

A

It is impaired

32
Q

What MAC do Hamot surgeons allow for checking evoked potentials?

A

1 MAC

33
Q

True or false:

Inhalation agents produce a dose dependent skeletal muscle relaxation and enhance the activity of NMBA?

A

True.

Can also be helpful on emergence. As gas comes off, NMBA effects will decrease.

34
Q

Which agents trigger MH?

A

Halothane>Forane (isoflurane),>Sevoflurane>Desflurane

35
Q

Which agents have hepatic effects/injury?

A

Halothane>sevoflurane>desflurane=iso=enflurane

36
Q

Renal effects are seen with what agent?

A

Sevoflurane

37
Q

What is produced from the breakdown of sevoflurane?

A

Compound A.

38
Q

What does the package insert say about sevo administration and renal effects?

A

If FGF <2L/min, must keep MAC fas flow to max of 2 hrs.

39
Q

Which agent is contraindicated in pneumothorax?

A

N2O

40
Q

Which deficiency would contraindicate N2O?

A

B12 Deficiency

41
Q

What is the blood:gas coefficient of the anesthetic gases?

A 
N2O=0.47
Des=0.45
Sevo=0.65
Iso=1.4
Halo=2.3
42
Q

When an air filled cavity has a compliant wall, what increases with N2O administration?

A

Volume

43
Q

When an air filled cavity has a non-compliant wall, what increases with N2O administration?

A

Pressure

44
Q

Degradation of CO2 Absorbent creates an exothermic or endothermic process?

A

Exothermic process (releases heat)

45
Q

Which agent has a specifically high production of compound A?

A

Sevoflurane

46
Q

What complications can arise from iso and des administration with a dessicated absorbent?

A

Can produce Carbon Monoxide

47
Q

What actions can prevent exothermic reactions or excess compound A production?

A 
PREVENTION:
Adequate hydration is key.
-change CO2 absorbent often.
-Turn FGF down or off during breaks.
-Limit FGF during cases.
-When in doubt, change it.
48
Q

What is the vapor pressure of des at sea level and 20 degrees C?

A

700mmHg

49
Q

TEC 6 vaporizer heats desflurane to how many ATM?

A

2 ATM

50
Q

Formula to calculate for changes in altitude?

A

(Desired vaporizer setting at sea level) x (760mmHg) / (Current ATM)

Pharmacology (9 decks)

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